Provider Demographics
NPI:1295921542
Name:AMES, TIMOTHY E (LMP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:AMES
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 B PARKMONT LANE SW
Mailing Address - Street 2:STE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502
Mailing Address - Country:US
Mailing Address - Phone:360-943-2940
Mailing Address - Fax:360-943-5616
Practice Address - Street 1:2625 B PARKMONT LANE SW
Practice Address - Street 2:STE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-943-2940
Practice Address - Fax:360-943-5616
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00021138OtherWA SATE DPT OF HEALTH